Professional Documents
Culture Documents
Voa Project-Communityservice
Voa Project-Communityservice
individuals and families. The VOA provides a variety of programs which include hunger
services. One VOA program serves individuals who have experienced a traumatic brain
injury (TBI) before the age of 18. Due to their impaired cognitive and/or physical
abilities, they are unable to care for themselves. Currently, there are three individuals who
meet this criteria and are provided supported living services by the VOA. Along with
shelter, the clients have access to food, water, and medical services. Additionally,
caregivers are available 24/7 to help the clients with activities of daily living (ADLs),
Because TBI patients frequently suffer from impaired cognitive and physical
disabilities, safety is a huge concern for this population. They are at an increased risk for
seizures, falls, and impulsive behaviors. After an in-home assessment, two principal
concerns identified were these clients lack of activity to stimulate their minds and the
lack of safe access to their backyard. The focus of this practice experience (PE) project
was to provide literature for the TBI program director which supports the need of safe
access to the backyard. The evidence provided focuses on safety as well as the benefits
associated with increased opportunities for therapeutic activities. Evidence found will be
used to help support a grant proposal to acquire funding for this project.
The Senior Director of Personal Support Services provided access to client history
as well as the clients physical residence. The house is located in a new, quiet subdivision
of Everett. At the time of assessment, the neighborhood area appeared clean and safe.
VOA Project 3
This assumption of safety was evidenced by people walking their dogs during the day and
several pedestrians present during the time of assessment. There were also several parks
and churches in the nearby neighborhood. The house itself was spacious with wood
flooring, two wheelchair accessible bathrooms, three bedrooms, and a backyard. The
Unfortunately, there are some drawbacks to where the house is located. There are
no clinics, dental offices, or social services nearby. The home is built on a hill, which
poses a safety concern for the clients using wheelchairs. There are no schools, libraries,
youth or senior centers close by, nor are there bus stops or public transportation centers
Although there are several disability service agencies in Everett, there are none within a
one-mile radius of the clients home. Because the house is located in a quiet, family-
oriented subdivision of Everett, there is concern for the neighborhoods perception of the
Although the house has been remodeled to fit the clients needs, there is room for
improvement. The backyard is not wheelchair accessible and only has stairs available
from the house to the lawn. The lawn is uneven and inadequately maintained. Other
safety concerns identified include a loose railing and unsteady large trees behind the
property. There is a history of one of these trees falling on the house next door to the
clients home. The bathrooms are small, making it difficult to bathe and transfer the
clients safely.
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These clients receive continuous care. Three caregivers are present at any one
time and are responsible for helping the clients bathe, eat, and perform other ADLs. A
wheelchair-accessible van is also available for caregivers to transport clients for shopping
needs, appointments, outings and other events. These caregivers are required to provide
techniques being utilized by staff. After interviews with the caregivers, concerns for
clients impulsive and aggressive behavior were identified. The caregivers also mentioned
a shortage of gloves and other necessary equipment to care for the clients. On the other
hand, the clients expressed boredom and reported the lack of activities. Lastly, the system
When looking at census data, the Everett area is a good place for individuals with
disabilities. The state average of disabled individuals is 8.9% while Everett has an
average of 12.3% living with a disability (United States Census Bureau, 2016).
Therefore, it could be inferred that there would be more people who would understand
the plight of living with a disability. Unfortunately, the poverty rate in Everett is higher
than the statewide average (United States Census Bureau, 2016). This may or may not
contribute to the high crime rate in Everett. The most reported crime in Everett is theft
(LexisNexis, 2017). This could be a concern for those living with a TBI because their
Recommendations
Several interventions were considered when preparing for this project. First, the
caregivers could be provided additional training and education on how to de-escalate the
clients during behavioral episodes. Second, providing the caregivers with handouts
illustrating examples of proper and improper charting and documentation could result in a
build a more user-friendly program, which would simplify the documentation process for
locations throughout the house was considered in order to reduce the number of
behavioral episodes from the clients and provide quick reference to caregivers during
client outbursts.
While these were valid concerns, a decision was made to prioritize other needs.
De-escalation training was provided for employees during job orientation and the VOA
handouts would not be useful for caregivers as they would not be used. Caretakers were
knowledgeable and felt confident in their documentation system. It was also felt that
current VOA staff would be most appropriate to design suitable programs related to their
daily processes. Many staff-members knew where to find the behavioral plans for the
clients and stated that on-the-job experience assisted more than the these written plans.
due to boredom, the most appropriate intervention was to create safer access to the
backyard. This project could address both safety and activity concerns. It was also
Due to clients personal budget concerns, the renovation of the deck and backyard
would require funding by state and/or federal grants. In order to obtain these grants, the
VOA must provide written proposals to justify why such funding would be best allocated
toward this project. To present such requests to the state, evidence was provided to the
VOA which supports that safe access to the clients backyard would ensure the clients
safety, result in an increase in daily activity and social interaction, as well as improve
Scholarly articles were retrieved which provided strong evidence supporting the
theory that access to green space would positively influence both mental and physical
behavior (Lee & Maheswaran, 2011). Another article confirmed the outdoor activity,
gardening, to cause a reduction in depression, anxiety, and body mass index (BMI) (Soga,
Gaston, & Yamaura, 2017). A third article addressed safety concerns by providing
(Northridge, Nevitt, Kelsey, & Link, 1995). A fourth article identified, provided evidence
Blake, 2010). Summaries of this evidence were written and provided to the program
Evaluation
Conducting a later assessment evaluating client behavior, interests, and fall risks
would effectively gauge if the clients new access to their backyard improved their
quality of life. These outcomes can be evaluated via in-house inspection or chart audit.
clients and staff, a decrease in desire to leave and an increase in participation in group
VOA Project 7
falls identifying time of day, cause, and medication usage would be adequate.
I enjoyed my time working with the VOA and learning about the assortment of
programs provided to our vulnerable populations. I have only recently learned about the
VOA itself and I am impressed how their TBI program provides such comprehensive care
for their clients. I was excited to learn that the three clients are cared for in a standard
home setting and was pleasantly surprised to find the home in a newer neighborhood
amongst domesticated families. I genuinely hope the three TBI clients find value in the
amongst them.
Making connections between the availability of services and some of the simple
even the recently proven greenspace and how these concepts impact community
members, was valuable learning experience. Although these concepts are not new, this
practice experience helped to provide a tangible sense of how life can be amongst
Working with the TBI house through the VOA has been an enlightening
experience. Nonprofits often have to stretch resources far in order to provide for all of the
needs of their clients. It's often difficult to staff these houses due to the lack of available
funds to provide decent wages for the caregivers. Because of this, there is a large turnover
with staff and the VOA spends most of its time with caregivers just providing initial
VOA Project 8
training. This makes implementing change within a house such as the TBI house difficult
the outside perspective to help improve the lives of the TBI clients and it is my hope that
Western Washington University RN-to-BSN students can continue to work with this
Partnering with the VOA has been a great and eye-opening experience. Ive
learned a lot about the resources they provide, as well as about the work that they do
aside from caring for clients with TBIs. Its been a pleasure getting to know the mentors
and caregivers. Ive learned that they, as well as many other non-profit organizations,
work incredibly hard to start and maintain programs to support vulnerable populations.
The work that they do is so important in health care prevention and community health
and is incredibly helpful in keeping people out of the hospital or the streets. As a nurse in
the emergency department, Im hoping to take back what Ive learned to tailor my care
References
VOA Project 9
Lee, A. C. K., & Maheswaran, R. (2011). The health benefits of urban green spaces: A
https://doi.org/10.1093/pubmed/fdq068
LexisNexis. (n.d.). LexisNexis Community Crime Map. Retrieved May 26, 2017,
from http://communitycrimemap.com/
Northridge, M. E., Nevitt, M. C., Kelsey, J. L., & Link, B. (1995). Home hazards and
falls in the elderly: The role of health and functional status. American Journal of
Soga, M., Gaston, K. J., & Yamaura, Y. (2017). Gardening is beneficial for health: A
https://doi.org/10.1016/j.pmedr.2016.11.007
United States Census Bureau. (n.d.). Population estimates, July 1, 2016, (V2016).
https://www.census.gov/quickfacts/table/PST045216/5322640,53